Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada.
Int J Gynaecol Obstet. 2011 Oct;115(1):5-10. doi: 10.1016/j.ijgo.2011.04.013. Epub 2011 Jul 26.
To evaluate the best available evidence regarding the association between single-layer closure and uterine rupture.
The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant observational and experimental studies that included women with a previous single, low, transverse cesarean delivery who had attempted a trial of labor (TOL). The risks of uterine rupture and uterine dehiscence were assessed by pooled odds ratios (OR) calculated with a random effects model.
Nine studies including 5810 women were reviewed. Overall, the risk of uterine rupture during TOL after a single-layer closure was not significantly different from that after a double-layer closure (OR 1.71; 95% confidence interval [CI] 0.66-4.44). However, a sensitivity analysis indicated that the risk of uterine rupture was increased after a locked single-layer closure (OR 4.96; 95% CI 2.58-9.52, P<0.001) but not after an unlocked single-layer closure (OR 0.49; 95% CI 0.21-1.16), compared with a double-layer closure.
Locked but not unlocked single-layer closures were associated with a higher uterine rupture risk than double-layer closure in women attempting a TOL.
评估关于单层缝合与子宫破裂之间关联的最佳现有证据。
检索 PubMed、Embase 和 Cochrane 对照试验中心注册数据库中关于有既往单一切口、低位、横行剖宫产史且尝试试产（TOL）的妇女的观察性和实验性研究。通过使用随机效应模型计算汇总优势比（OR）来评估子宫破裂和子宫破裂的风险。
共纳入 9 项研究，涉及 5810 名妇女。总体而言，TOL 后单层缝合的子宫破裂风险与双层缝合无显著差异（OR 1.71；95%置信区间 [CI] 0.66-4.44）。然而，敏感性分析表明，与双层缝合相比，锁边单层缝合（OR 4.96；95% CI 2.58-9.52，P<0.001）后的子宫破裂风险增加，但非锁边单层缝合（OR 0.49；95% CI 0.21-1.16）后的子宫破裂风险并未增加。
与双层缝合相比，尝试 TOL 的妇女中，锁边单层缝合而非非锁边单层缝合与更高的子宫破裂风险相关。
